Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2023, Vol. 37 ›› Issue (6): 6-14.doi: 10.6040/j.issn.1673-3770.0.2023.172

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Comparison of upper airway anatomical changes during mandibular protrusion and with mandibular advancement device use

LI Yanru1, SHI Yunhan1, CAO Lili1, LIAO Jianhong1, KANG Dan1, FEI Nanxi2, HAN Demin1   

  1. 1. Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery(Capital Medical University ), Ministry of Education, Beijing 100730, China2. Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
  • Published:2023-12-15

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Abstract: Objective This study aimed to investigate the changes in the upper airway structure during mandibular protrusion and the use of an oral appliance(OA)in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS). Additionally, we explored whether the alterations in the pharyngeal cavity caused by mandibular protrusion could predict structural increment with OA use. Methods Upper-airway MRI was performed on 24 adult patients with OSAHS and 20 controls while awake, during mandibular protrusion, and while wearing an OA. The consistency of anatomical changes in different pharyngeal areas during mandibular protrusion and while wearing an OA was assessed. The characteristics of patients with enlarged retropalatal and retroglossal airways when using an OA were analyzed. Results The apnea-hypopnea index(AHI)of the OSAHS group was 41.8(15.9, 53.5)times/h, and the lowest oxygen saturation was(80.2±9.5)%. Both mandibular protrusion and OA use significantly increased the distance between the mandible and the posterior pharyngeal wall in the OSAHS and control groups(t=-6.853, P<0.001; t=-8.641, P<0.001). The increment with mandibular protrusion was more significant than that with OA use(P<0.05). An increased minimum cross-sectional area and volume in the retropalatal area were observed with OA use. Moreover, the increment with mandibular protrusion was more significant than mandibular protrusion(Z=-2.057, Z=-2.543 in the OSAHS group; Z=-0.201, Z=-2.254 in the control group). Compared with OA use, mandibular protrusion caused a greater increment in the epiglottic area in the control group(Z=2.365). Meanwhile, in patients with OSAHS, a greater increment in the epiglottic area and volume of the retroglossal area were observed with OA use(Z=-2.236, Z=-2.171). The following parameters had predictive value for identifying patients who had enlarged retropalatal and retroglossal airways with OA use: changes in the epiglottic cross-sectional area during mandibular protrusion ［OR=5.489(1.691, 17.815)］, changes in the retropalatal airway minimum cross-sectional area during mandibular protrusion ［OR=4.589(1.320, 15.953)］, and the AHI ［OR=0.935(0.898, 0.974)］. Conclusion The changes in the upper airway structure during mandibular protrusion are consistent with those for OA use. However, certain differences in the amplitude of anatomical changes in different regions of the upper airways were noted. The changes in the pharyngeal cavity area during mandibular protrusion may have predictive value for selecting candidates for mandibular advancement device treatment.

Key words: Sleep apnea, Obstructive, Oral appliance, Mandibular advancement, Upper airway

CLC Number: 

  • R766
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